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Adenoid facies

Adenoid
facies is the long, open-mouthed, dumb-looking face of children with adenoid
hypertrophy. Hypertrophy of the nasopharyngeal pad of lymphoid tissues (the
adenoids) is the most common cause of nasal obstruction in children. The mouth
is always open because upper airway congestion has made patients obligatory
mouth breathers. Persistent mouth breathing due to nasal obstruction in
childhood may be associated with the development of craniofacial anomalies such
as the adenoid facies ( also called the
“long face syndrome”. The most common presenting symptoms are chronic mouth
breathing and snoring” The most
dangerous symptom is sleep apnea.

The
characteristic facial appearance consists of:

underdeveloped
thin nostrils

short
upper lip

prominent
upper teeth

crowded
teeth

narrow
upper alveolus

high-arched
palate

hypoplastic
maxilla

Adenoid
facies is also typical of recurrent upper respiratory tract allergies. It is
diagnostic features are:

Dennie`s lines, which are horizontal creases under both
lower eyelids (first described by the American physician Charlies Dennie)

a
nasal pleat, which is the horizontal crease just above the tip of the nose
produced by the recurrent upward wiping of nasal secretions

allergic
shiners, which are bilateral shadows under the eyes produced by chronic venous
congestion. Incidentally, upward wiping of nasal secretions with either the
palm or the dorsum of the hands is so common that often it is called the “allergic
salute”. Finally, adenoid facies can be part of Cowden syndrome

Diagnosis

Enlarged
adenoids are not easily identified on physical examination. A lateral
radiograph of the nasopharynx provides a simple and cost-effective method for
assessing the size of adenoids and the amount of post-nasal airway space
remaining.